Department of Big Data in Health Science School of Public Health Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States.
Front Public Health. 2022 Oct 26;10:1012223. doi: 10.3389/fpubh.2022.1012223. eCollection 2022.
Hyperuricemia is prevalent and associated with individual cardiometabolic diseases, highlighting the potential role of serum uric acid (SUA) in the development and progression of cardiometabolic multimorbidity (CMM, the coexistence of diabetes, heart disease, or stroke). This study aimed to examine the role of SUA change in the progression of CMM.
This prospective cohort study used data from the China Health and Retirement Longitudinal Study, included 4,820 participants aged 45 years or above with three complete surveys at 2011 (baseline), 2015, and 2018. SUA level at survey 2011 and 2015 was used to measure SUA change as keeping or rising to hyperuricemia, and keeping or declining to non-hyperuricemia. CMM progression was defined as the first report of CMM or additional report of cardiometabolic diseases during survey 2015 and 2018. We used logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of SUA change on CMM progression.
During the follow-up of around 7 years, 519 (10.8%) of the participants kept or rose to hyperuricemia from survey 2011 to 2015, and 311 (6.5%) experienced CMM progression from survey 2015 to 2018. Participants who kept or rose to hyperuricemia had 1.86 (95% CI, 1.29, 2.68) increased odds of CMM progression compared with those who kept or declined to non-hyperuricemia. Specifically, keeping or rising to hyperuricemia (vs. keeping or declining to non-hyperuricemia) was associated with 2.01 times higher odds (95% CI, 1.18, 3.43) of incident diabetes and 1.67 times higher odds (OR:1.67; 95% CI, 1.15, 2.43) of incident cardiovascular diseases following diabetes.
Keeping or rising to hyperuricemia was associated with CMM progression, particularly with incident cardiovascular diseases following diabetes. These findings suggest that monitoring SUA change may provide innovative insights into the prevention of CMM, especially in the secondary prevention of CMM (i.e., preventing further progression to cardiovascular diseases among patients with diabetes).
高尿酸血症较为普遍，与多种心血管代谢疾病相关，这突出表明血清尿酸（SUA）在心血管代谢性多病症（CMM，即糖尿病、心脏病或中风的共存）的发生和发展中可能发挥作用。本研究旨在探讨 SUA 变化在 CMM 进展中的作用。
本前瞻性队列研究使用了中国健康与退休纵向研究的数据，纳入了 4820 名年龄在 45 岁及以上、在 2011 年（基线）、2015 年和 2018 年完成了三次完整调查的参与者。使用 2011 年和 2015 年的 SUA 水平来衡量 SUA 变化，即保持或升高为高尿酸血症，或保持或降低为非高尿酸血症。CMM 进展定义为在 2015 年和 2018 年的调查中首次报告 CMM 或额外报告心血管代谢疾病。我们使用逻辑回归模型来估计 SUA 变化对 CMM 进展的比值比（OR）和 95%置信区间（95%CI）。
在大约 7 年的随访期间，有 519 名（10.8%）参与者从 2011 年到 2015 年保持或升高为高尿酸血症，有 311 名（6.5%）参与者从 2015 年到 2018 年经历了 CMM 进展。与保持或降低为非高尿酸血症的参与者相比，保持或升高为高尿酸血症的参与者发生 CMM 进展的几率增加了 1.86 倍（95%CI，1.29，2.68）。具体而言，与保持或降低为非高尿酸血症相比，保持或升高为高尿酸血症与新发糖尿病的几率增加 2.01 倍（95%CI，1.18，3.43）和新发心血管疾病的几率增加 1.67 倍（OR：1.67；95%CI，1.15，2.43）相关。
保持或升高为高尿酸血症与 CMM 进展相关，特别是与新发糖尿病后的心血管疾病相关。这些发现表明，监测 SUA 变化可能为预防 CMM 提供新的思路，特别是在 CMM 的二级预防（即在糖尿病患者中预防进一步进展为心血管疾病）方面。
